Ankle Injury Rapid Recovery – Details Make a Huge Difference – Vol. 2

So far, you haven’t heard anything about R.I.C.E.. The problem with that acronym is the lack of detail with which it is presented. R.I.C.E. assumes swelling has occurred and range of motion is lost.  Preserving range of motion is the key to a rapid recover and is why preventing swelling is paramount. R.I.C.E. has no sense of urgency in its tactics or proactive stance against swelling. Rest, Ice and Elevation play a role, but Compression is by far the most important tool in the treatment plan. The R.I.C.E. plan completely ignores the importance of compression. But, it’s not just general compression that you’re after.

If our ankles were cylindrical, without high and low areas, an elastic wrap by itself would work well. However, applying a wrap to an injured ankle forces swelling into the little hollow areas around the ankle knobs, robbing the joint’s motion, which is exactly what you don’t want. Focal Compression methods use simple devices to fill the hollow areas around the ankle so that an equal amount of pressure from the wrap is applied throughout. If you’ve wondered how a big time athlete can be back in action in a few days when it takes the “average Joe” weeks, this method is likely the reason. It makes a huge difference.

Felt or foam pads in horseshoe and donut shapes are standard as Focal Compression devices go. The FIRSTEP™ Fast Ankle Caredonut pads are self-adhering, like band-aids. Once compressed under a wrap they’ll stay stuck even in the shower or ice bucket.  They are a big improvement and make self-care simple. Home made devices include a disposable baby diaper, coiled tube sock, or any pliable material on hand that could fill the hollows around the ankle knobs under a wrap.

Having a kit ready to go is imperative. If you have to go looking for these items after you’re hurt you’ll be out of luck as swelling will win the battle of time. Typically, this method can manage swelling within 24-36 hours. This is also the best method for resolving swelling. So, even if it’s the next day, this method works better than any other at managing swelling from an ankle injury. To rehab the lateral muscle and tendon complex that controls normal ankle function you need full range of motion. It’s much easier to retain it than it is to regain it. Focal Compression will be your best friend in accomplishing this task.

Rest is a given. Get off the injury and give it a chance to mend.  Appropriate non-weight bearing measures will vary widely by person and injury.  The single greatest reason that any therapy fails is due to patient non-compliance. Be your own best friend and follow the directions….

Ice is misunderstood. It’s reported that doctors initially said to use ice believing that people could figure out for themselves that that would mean heat would be a bad thing, or so the story goes. The myth of ice is that it will prevent swelling, which it won’t. The human body usually functions where cold compression will prevent swelling. But, then it’s more from the compression than it is the cold.  Ice has a positive impact in reducing pain and does contribute to reducing swelling, but not preventing it.

As mentioned, compression and cold together are a good combination.  Practicality or Murphy’s Law would seem to dictate that the better ice would be to have, the harder it is to find.  Ice is nice when available. But, it is not a preventative measure for swelling and should be used as an adjunct to focal compression in the early phase of injury management.  Crushed ice is highly preferred as it can be compressed into those hollow areas around the ankle knobs functioning as a focal compression / cold therapy delivery system with 20 minutes cycles of treatment standard. Maybe you’ve seen this method applied on the sidelines, but in the training room afterwards a focal compression wrap is a gold standard.

Last but not least is Elevation. The idea is simply that gravity works and an ankle elevated above the level of your heart will naturally swell less. The often-overlooked opportunity where one can gain the most ground against swelling is overnight in bed.  This is where the value of the FIRSTEP™ Fast CareKit really makes a difference.  The wrap is comfortable and easy to manage. Velcro closures on each end allow for a quick easy start and a secure finish. With the donut pads stuck to you, both hands are free to apply the wrap. The self-adhering feature also eliminates the need for assistance in re-applying the wrap on your own. This factor alone significantly improved athlete compliance during a 90-day evaluation at the US Naval Academy. A pearl they shared with us is the best way to elevate an ankle overnight.  Using a thick pillow, phone book, shoebox or suitcase between the bed’s mattress and box springs elevates the whole end of the bed ideally.  This doesn’t change the geometry of sleeping as trying to keep your foot on a pillow does. You can’t kick it off of the bed or roll off of this elevator when it’s under the mattress.  It’s a simple solution that works well.

We will explore further details and testimonials of OverNight Ankle Care in our next post.